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Weight Loss Surgery: They Don’t Operate On Your Brain

by Cheryl Forberg, RD on March 22, 2012

First the good news if you’re a candidate for weight-loss surgery: By having such a procedure, your odds of living longer than someone who doesn’t might be greatly increased.

A recent study released by researchers in Milan, Italy, found that patients with obesity who underwent some form of bariatric procedure reduced their odds of dying by almost half compared to their counterparts who did not have the surgery.

Researchers analyzed data from eight clinical trials involving more than 44,000 obese men and women. About 14,000 of the subjects actually had some form of bariatric surgery — either gastric bypass or stomach banding — and the rest served as control subjects for comparison. The trials included an average of 7.5 years of follow-up.

Of the roughly 3,300 deaths among all participants, 2.8 percent had had a bariatric procedure; 9.7 percent did not have surgery. Thus, patients who underwent bariatric surgery had 45 percent lower odds of dying. The team found a similar benefit when it looked specifically at heart-related deaths. Overall, death rates were comparable for the approximately 10,000 banding and 4,000 gastric bypass surgeries, although the protective effects on heart-related deaths differed: Compared to no surgery, banding provided 29 percent lower odds of heart-related death vs. a 52 percent risk reduction with bypass.

The risks

The message here is not that surgery is the only solution to obesity — which we know leads to all kinds of health problems and many preventable deaths. As is proven every season by the contestants on The Biggest Loser, invasive, risky and expensive surgery isn’t the only way to shed large amounts of fat. But for people with severe obesity who are unable to manage their diet and exercise, it is an option — one to be carefully considered with the help of a trusted doctor.

Bariatric surgery isn’t cheap — this procedure will set you back between $14,000 and $26,000. But that’s not the only cost: The potential for complications leading to severe health problems and even death can’t be overlooked. These risks include staple/suture ruptures resulting in stomach acid leaks into the body, as well as infections, hemorrhages, ulcers, bowel issues and nutritional deficiencies. The numbers are tough to pin down, but estimates for overall complication rates vary from seven percent to as much as 20 percent; mortality rate estimates range from less than one percent to as much as two percent, depending on the study. Again, not a procedure to be taken lightly!

Another important thing to consider is that many people actually have some type of bariatric surgery only to gain the weight back again later. That’s right — this surgery is not a fail-safe weight-loss solution. Some of the contestants on The Biggest Loser can attest to this fact. Recently I had a chance to sit down with Jessica Delfs, one of the BL10 contestants who had weight loss surgery prior to appearing on the show. (You can read our Q+A on the subject here.)

They don’t operate on your brain.

“The surgery, no matter how involved, is just a tool and doesn’t change your brain and/or relationship with food. That has to change for long-term success,” says Margaret Furtado, a clinical dietitian specialist at Johns Hopkins Bayview Medical Center who specializes in bariatric surgery. “There are certainly ways to sabotage the band, as well as gastric bypass, and, as I say every day to my patients both pre- and post-operative bariatric surgery, ‘They don’t operate on your brain!’”

The band actually has a high failure rate: Her statistics show that 50 percent of people who have adjustable gastric banding surgery fail to lose 30 percent of their excess weight. (30-50 percent is considered successful.) Gastric bypass statistics reveal that the average result is 60-70 percent of excess body weight loss and some weight regain — 5 to 10 percent is normal. The newer bariatric procedure, sleeve gastrectomy (aka “the sleeve”), is now gaining popularity, and excess weight loss is about 40 to 60 percent given five-year data in the U.S.

“In my 10 years or so working with gastric banding at Tufts, Mass General and now Hopkins, I have seen only a handful of patients lose all of their excess body weight,” says Furtado. “In my experience, corroborated by statistics and conference talks, people who are ‘volume eaters’ versus ‘grazers’ tend to do better with the band as a tool. It’s like a funnel, so snacks, liquid calories, etc. go right down without problems. The more fills/adjustments clients have, the more they can’t tolerate meat, chicken and vegetables, and so a too-tight band can cause people to eat only junk foods and/or liquid calories, unfortunately.”

Research reveals that a purely restrictive bariatric procedure, like gastric banding, doesn’t change genetic or physiological barriers keeping you to a certain weight range. What’s more, the brain “fights” the weight loss for up to one full year after weight loss from dieting or even the band, so regular physical activity and a healthy diet with protein at every meal are vital to help long-term success.

Bariatric surgery procedures like gastric bypass and the newer gastric sleeve are considered “metabolic” surgeries in that they help increase metabolism for about six months or so after surgery, and help send a message to the brain to go to a lower physiological set point or lower weight thermostat. However, it’s imperative that healthy eating, including protein at least three times a day, and regular exercise be a part of the prescription to help these tools work best. Adequate sleep and stress management are also key to long-term weight loss success.

It is of the utmost importance that people change their relationship with food and exercise to keep the weight off after weight-loss surgery of any kind.

The opinions expressed in this article are in no way intended as a substitute for medical advice. Consult your doctor when considering this or any other medical procedure.